EntityNameParts
We must get used to the notion that patients not always have to provide their real names. And that in order to provide healthcare we need to know the real (administrative) identity. Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 17 Mar 2005, at 13:50, Grahame Grieve wrote: At 11:29 PM 17/03/2005, you wrote: Richard is often abbreviated to Dick in English usage. No idea what the origin is - lost in the mists of time. So, if you get initial = D given = Richard you don't know that the D is an abbreviation for Richard. And if you do know that it is, there's no way to say so Well, is there a *need* to say so ? What's fundamentally wrong with just storing the D as a second first name along with Richard ? I probably am too much of a pragmatist. hi Karsten depends which hat I'm wearing. If I'm programming, then I probably won't care - delegate the problem to the user. If I'm wearing my standards hat, or writing a reference demographics server, then I would care Grahame -- next part -- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 1211 bytes Desc: not available URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050426/b5c55b72/attachment.bin
OIDs / II
Dear all, My ideas: - unique identifiers are numbers that are unique. - each collection of information that has an attribute with this unique number can be collected and presented as belonging together, - with one unique identifier per (pseudo)identity all information belonging to this unique identifier can be collected and presented as belonging together - this type of use is identifying documents (or parts of it) as containing information about the same person with a specific identity. - it is NO PROOF of the real identity of the person. That is a different matter. - When we have to uniquely identify persons we need other things than numbers. - Unique numbers must not be trusted. - Unique numbers that identify persons generate problems: identity theft. - Only knowledge that is known by the person, or features his body posesses, will help to identify persons. Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 20 Apr 2005, at 12:43, Bert Verhees wrote: Dear Grahame, For example the CEN GPIC subjectofcare which has a property id The type is a Set of II The use is excplained as: An identifier or identifiers that may be used to uniquely identify the subject of care. Examples: social security number, health service number, hospital number, case notes number Please indicate where there is a mismatch between the intention and the use of II. CENTC251 could learn from that. It would be a great benefit to the standard if this would be sorted out. And if it will, then the need for an extra qualifier to tell which the type of identifier is presented, may disappear, depending on your solution Kind regards Bert Verhees -- next part -- A non-text attachment was scrubbed... Name: not available Type: text/enriched Size: 1829 bytes Desc: not available URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050426/14704952/attachment.bin
OIDs / II
Op dinsdag 26 april 2005 07:52, schreef Gerard Freriks: Dear all, My ideas: - unique identifiers are numbers that are unique. this is not true, not the numbers are unique, the number in context of something (social security, insurancenumber, etc) is or should be unique. - each collection of information that has an attribute with this unique number can be collected and presented as belonging together, it is not that simple, a collection of information can have more then one number, and the CEN-standard does not provide meta-information in some cases, f.e. PatientExtendedInformation carries a SetII, which is a set of numbers (identifiers), those numbers in a list do not have meta-information, except for the OID, but that meta-information can only be resolved over a network-service (which does not yet exist). f.e. You retrieve a PatientExtendInformation-object from a information-system. And it carries a few numbers. You have to know which one is the socialsecurity number, you have to resolve the OID. That is possible, when you have an Internet connection and the resolving OID-service is up and running, which not always may be the case. We are talking about a standard CEN, which has the intention to solve all information problems world-wide Sometimes you don't have an Internet-connection (f.e. firewall restrictions) Sometimes the OID is not know at the resolving service (OID from an other country, which has no resolving OID exchange with our country) Sometimes there is no OID (a less developed country) Sometimes the resolving service is unreachable (down, hacked, whatever) But, even when this is all working well, the following situation You are online datamining, and you do not retrieve one PatientExtendedInformation, but 1.000.000. The fact that you have to resolve all OID's will slow your datamining down very much, and unnecessary. It could slow down that much that it is unacceptabel for a customer, and the world has to live without that datamining application, or the customer will want to look for another standard to work with. I once wrote an application which did analyse firewall-logging, the analysing was a matter of seconds, some nifty mathematical algorithms over the logging database. But then the customer also wanted to know from which companies the IP-addresses where coming from, so the analysing application had to resolve the IP-addresses. Happily, DNS is a very good system, worldwide implemented (although there are problems with NAT, which is sometimes region wide -implemented (China) because of lack of unfair sharing of availble IP-addresses) The customer was not happy, first the application slowed down, what was first done in a few seconds, took an hour ore more (factor 1000 or more), second, the result was not satisfactory because of NAT and other resolving issues. This problem can easily be solved when the II-object is extended with a qualifier which tells us what kind of an II you are looking at. f.e. You want to know at which insurance company a million of patients are insured, and every patient carries 10 numbers, without this qualifier you have to resolve 10 numbers from each patient to find that one which is of interest, that means 10.000.000 resolving actions, where 1.000.000 would do if there was a qualifier, it means 9.000.000 resolving actions too many - with one unique identifier per (pseudo)identity all information belonging to this unique identifier can be collected and presented as belonging together - this type of use is identifying documents (or parts of it) as containing information about the same person with a specific identity. - it is NO PROOF of the real identity of the person. That is a different matter. - When we have to uniquely identify persons we need other things than numbers. - Unique numbers must not be trusted. - Unique numbers that identify persons generate problems: identity theft. - Only knowledge that is known by the person, or features his body posesses, will help to identify persons. It, thus, its only use is not to identify a person, that is only one purpose of an information system. Also there is an other problem with OID's, a identity may not have an OID, I guess this will happen a lot, certainly in the coming few years. In that case, there has to be an OID which indicates that there is no-one. This is necessary because OID is a mandatory property in the II-type. In that case, your need for a qualifier is even more urgent. There may be other solutions then a qualifier to this problem, but the current situation in the standard is in my opinion not sufficient regards Bert Verhees Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 20 Apr 2005, at 12:43, Bert Verhees wrote: Dear Grahame, For example the CEN GPIC subjectofcare which has a property id The type is a Set of II The use is
EntityNameParts
Op dinsdag 26 april 2005 07:37, schreef Gerard Freriks: We must get used to the notion that patients not always have to provide their real names. And that in order to provide healthcare we need to know the real (administrative) identity. When you build a system that is only usable when you have a working Internet-connection, in my humble opinion, this is a bad system. There are many situations where you don't have good networks, think of war, tsunamies, big disasters, maybe you want to register people for the healthcare they get, but if a stupid application refuses to accept a patient, because the OID cannot be resolved (when you say mandatory to a programmer, he will make it mandatory), tha application will be useless. But this example is beyond the scope of my problems (for now). Bert Gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 17 Mar 2005, at 13:50, Grahame Grieve wrote: At 11:29 PM 17/03/2005, you wrote: Richard is often abbreviated to Dick in English usage. No idea what the origin is - lost in the mists of time. So, if you get initial = D given = Richard you don't know that the D is an abbreviation for Richard. And if you do know that it is, there's no way to say so Well, is there a *need* to say so ? What's fundamentally wrong with just storing the D as a second first name along with Richard ? I probably am too much of a pragmatist. hi Karsten depends which hat I'm wearing. If I'm programming, then I probably won't care - delegate the problem to the user. If I'm wearing my standards hat, or writing a reference demographics server, then I would care Grahame -- Met vriendelijke groet Bert Verhees ROSA Software - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
Specification Humor
..and on the lighter side: http://lists.xml.org/archives/xml-dev/200504/msg00260.html http://lists.xml.org/archives/xml-dev/200504/msg00245.html Have a great day! -- Tim Cook Key ID 9ACDB673 @ http://www.keyserver.net/en/ -- next part -- A non-text attachment was scrubbed... Name: signature.asc Type: application/pgp-signature Size: 189 bytes Desc: This is a digitally signed message part URL: http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050426/ae6b84eb/attachment.asc
uncertainty in medical problem solving and decision making (Was: Dr R LONJON Confidence indicator !
Hi Arild, Another site is the MIT Group on Clinical Decision Making: [ http://medg.lcs.mit.edu/ ]. ... a research group dedicated to exploring and furthering the application of technology and artificial intelligence to clinical situations. Because of the vital and crucial nature of medical practice, and the need for accurate and timely information to support clinical decisions, the group is also focused on the gathering, availability, security and use of medical information throughout the human life cycle and beyond ... Unfortunately Patient decision-making receives less emphasis and studies seem to miss some fundamental factors (e.g., it is private) [ http://www.ahrq.gov/research/rtisumm.htm ] Regards! -Thomas Clark Arild Faxvaag wrote: Hi all. This is an important topic. Here are some references / pointers for those who wish to read more: Decision making in health and medicine. Integrating evidence and values Myriam Hunink and Paul Glasziou Cambridge university press (ISBN 0 521 77029 7) Society for Medical Decision Making: http://www.smdm.org/ I also recommend journal articles written by Wimla L Patel (Colombia university, New York), for instance: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrievedb=pubmeddopt=Abstractlist_uids=11418539 (A primer on aspects of cognition for medical informatics) regards arild Faxvaag P 22. apr. 2005 kl. 07.42 skrev Gerard Freriks: -1- Almost never a diagnosis is 100% certain. -2- Almost always a test result has uncertainty attached to it -3- Many times a conclusion is reached based on many uncertain and conflicting facts -4- Quite often a condition, a diagnosis, is assumed that gives rise to a treatment. Not indicating that the patient is suffering from this condition but using treatment as a test procedure. Doing nothing is such a test procedure. Eric Wulff (from Danmark) published philisophical texts about health care and these topics. gerard -- private -- Gerard Freriks, arts Huigsloterdijk 378 2158 LR Buitenkaag The Netherlands +31 252 544896 +31 654 792800 On 20 Apr 2005, at 13:58, Thomas Beale wrote: I'm wondering if there is a meta-algorithm of some sort lurking behind the scenes, which takes account of uncertainty in a note, and also severity of non-discounted possibilities, as a way of deciding what to do next. There is undoubtedly published work on this... thoughts? - thomas beale -- Arild Faxvaag associate professor / rheumatologist Adress / Office St.Olavs hospital: Department of Rheumatology, St.Olavs hospital N-7006 Trondheim, Norway Phone Dept of Rheumatology 47 7386 7263 Adress / Office NTNU Norwegian center for electronic patient records research (NSEP) Medisinsk teknisk forskningssenter N-7489 Trondheim Cellphone: 47 9821 6825 http://www.ntnu.no/~arildfa/ (home page NTNU) http://www.usemed.com (weblog on e-medicine) http://www.ehr.ntnu.no/e (Norwegian Centre for Electronic Health Records Research) - If you have any questions about using this list, please send a message to d.lloyd at openehr.org
